Abstract
Purpose :
Advancements in technology allow cataract surgeries to be performed in diverse environments, including hospital-based outpatient departments (HOPD) and ambulatory surgical centers (ASC), which raises questions about variability in surgical times and factors contributing to those differences. This study explores the operative efficiency of cataract surgery across various healthcare settings, comparing dedicated and non-dedicated ophthalmology surgery centers.
Methods :
A retrospective analysis of 8,831 cataract surgeries performed between 2021 and 2022 across three sites (non-ophthalmic HOPD, ophthalmic HOPD, and ASC) operated by a tertiary academic medical center was conducted. Average times at each site were compared with Welch T-test. A survey was completed by various ophthalmologists operating at both the ASC and HOPD sites to qualitatively assess differences between sites.
Results :
The analysis included 7,715 simple and 1,116 complex cataract surgeries (66 and 34 at the non-ophthalmic HOPD, 6,387 and 988 at the ophthalmic HOPD, 1,262 and 94 at the ASC). For simple cataract surgery, the mean difference in operating times between the non-ophthalmic HOPD and ophthalmic HOPD was 19.6 minutes (95% CI=12.9-26.3; p<0.0001). The difference between the non-ophthalmic HOPD and ASC was 22.8 minutes (95% CI=16.0-29.6; p<0.0001). The difference between the ophthalmic HOPD and ASC was 3.2 minutes (95% CI=2.7-3.7, p<0.0001). Similar trends existed for complex cataract surgery for the non-ophthalmic and ophthalmic HOPD [34.6 minutes (95% CI=20.1-49.1; p<0.0001)], the non-ophthalmic HOPD and ASC [38.9 minutes (95% CI=24.1-53.7; p<0.0001], and the ophthalmic HOPD and ASC [4.3 minutes (95% CI=0.7-7.9, p=.0201)]. Of the surveyed surgeons, 57% perceived that cataract surgery requires more than double the time in a non-ophthalmic surgical setting. Survey responses indicated that medical complexity, staff training, and operating room equipment availability were key factors influencing the observed differences.
Conclusions :
Dedicated ophthalmology centers have a significant impact on surgical time savings in cataract surgery. Additional time and expense associated with non-ophthalmic HOPDs should be considered in cataract surgery reimbursement.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.